483: Social vulnerability among foreign-born pregnant women and maternal virologic control of HIV

Objective The aim of this study was to assess whether social vulnerability among foreign-born pregnant women living with HIV is associated with maternal viremia during pregnancy. Study Design This retrospective cohort study included all foreign-born pregnant women living with HIV who received prenatal care in a multidisciplinary prenatal clinic between 2009 and 2018. A licensed clinical social worker evaluated all women and kept detailed clinical records on immigration status and social support. Social vulnerability was defined as both living in the United States for less than 5 years and reporting no family or friends for support. The primary outcome was evidence of viral non-suppression after achievement of initial suppression. Secondary outcomes were the proportion of women who required > 12 weeks after starting antiretroviral therapy to achieve viral suppression, median time to first viral suppression (in weeks) after initiation of antiretroviral therapy, and the proportion who missed ≥ 5 doses of antiretroviral therapy. Bivariable analyses were performed. Results A total of 111 foreign-born women were eligible for analysis, of whom 25 (23%) were classified as socially vulnerable. Social and clinical characteristics of women diverged by social vulnerability categorization but no differences reached statistical significance. On bivariable analysis, socially-vulnerable women were at increased risk for needing > 12 weeks to achieve viral suppression (relative risk: 1.78, 95% confidence interval: 1.18–2.67), though there was no association with missing ≥ 5 doses of antiretroviral therapy or median time to viral suppression after initiation of antiretroviral therapy. Conclusion Among foreign-born, pregnant women living with HIV, markers of virologic control during pregnancy were noted to be worse among socially-vulnerable women. Insofar as maternal viremia is the predominant driver of perinatal transmission, closer clinical surveillance and support may be indicated in this population. Key Points

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Social vulnerability: The connection between psychiatric disorders and thiamine deficiency in pregnant women

Psychiatry Research ◽

10.1016/j.psychres.2020.113362 ◽

2020 ◽

Vol 293 ◽

pp. 113362

Author(s):

Fernando Machado Vilhena Dias ◽

Aline Sanches Oliveira ◽

Cláudio S. Dias Júnior ◽

Glaura C. Franco ◽

Antônio L. Teixeira ◽

...

Keyword(s):

Pregnant Women ◽

Psychiatric Disorders ◽

Social Vulnerability ◽

Thiamine Deficiency

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Higher prevalence of childbirth related fear in foreign born pregnant women – Findings from a community sample in Sweden

Midwifery ◽

10.1016/j.midw.2014.11.011 ◽

2015 ◽

Vol 31 (4) ◽

pp. 445-450 ◽

Cited By ~ 48

Author(s):

Elin Ternström ◽

Ingegerd Hildingsson ◽

Helen Haines ◽

Christine Rubertsson

Keyword(s):

Pregnant Women ◽

Community Sample ◽

Foreign Born

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Antiretroviral Therapy in Pregnant Women

10.1093/med/9780190493097.003.0026 ◽

2017 ◽

Author(s):

William R. Short ◽

Jason J. Schafer

Keyword(s):

Pregnant Women ◽

Antiretroviral Drugs ◽

Virologic Suppression ◽

Mother To Child Transmission ◽

Child Transmission ◽

Virologic Control ◽

Treatment Changes ◽

Mother To Child ◽

Hiv 1 ◽

Pregnancy Registry

Research has demonstrated that proper prevention strategies and interventions during pregnancy, labor, and delivery can significantly reduce the rate of mother-to-child transmission of HIV. Antiretroviral drugs (ARVs) should be initiated in all HIV-infected pregnant women regardless of CD4+ T cell count or HIV-1 RNA level. ARVs should be given in combination therapy, similar to nonpregnant patients, with the goal of complete virologic suppression. Treatment changes during pregnancy have been associated with the loss of virologic control and independently associated with mother-to-child transmission. All cases of prenatal antiretroviral exposure should be reported to the Antiretroviral Pregnancy Registry, which collects data on HIV-infected pregnant women taking ARVs with the goal of detecting any major teratogenic effects.

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Dietary intake in pregnant women in a Spanish Mediterranean area: as good as it is supposed to be?

Public Health Nutrition ◽

10.1017/s1368980012003643 ◽

2012 ◽

Vol 16 (8) ◽

pp. 1379-1389 ◽

Cited By ~ 17

Author(s):

Clara L Rodríguez-Bernal ◽

Rosa Ramón ◽

Joan Quiles ◽

Mario Murcia ◽

Eva M Navarrete-Muñoz ◽

...

Keyword(s):

Fatty Acids ◽

Dietary Intake ◽

Pregnant Women ◽

Vegetable Intake ◽

First Trimester ◽

Dietary Guidelines ◽

Institute Of Medicine ◽

Foreign Born ◽

Cross Sectional ◽

Total Fat

AbstractObjectiveTo assess food and nutrient intakes and compliance with nutritional recommendations in pregnant women according to selected sociodemographic characteristics.DesignCross-sectional study based on data from the INMA-Valencia cohort (Spain), which recruited pregnant women between 2004 and 2005. Information on maternal sociodemographics and anthropometry was collected. Dietary intake was assessed through an FFQ. Intakes of foods were compared with Spanish food-based dietary guidelines. Intake inadequacy for nutrients was assessed using the Dietary Reference Intakes of the US Institute of Medicine.SettingValencia, Spain.SubjectsWe studied 822 pregnant women who had information on dietary intake during their first trimester of pregnancy.ResultsMore than 50 % of pregnant women did not meet the guidelines for cereals and legumes; reported intakes of carbohydrates, n-3 and n-6 fatty acids were below recommendations and exceeded the total fat intake according to dietary references. Dietary inadequacy for folate, Fe and vitamin E ranged from 99 % to 68 %. Vegetable intake was related to age only. Younger and less educated women showed lower intakes of protein and n-3 fatty acids and higher intakes of trans-fatty acids as well as greater inadequacy for micronutrients. Spanish women reported lower intakes of fruit and carbohydrates and higher intakes of protein, total fat, SFA, MUFA and n-3 fatty acids compared with their foreign-born counterparts.ConclusionsWomen in the studied area have inadequate intakes of several nutrients relevant during pregnancy. Age, education and country of origin are factors significantly related to dietary intake and adequacy.

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Prevalence of syphilis and HIV infection during pregnancy in incarcerated women and the incidence of congenital syphilis in births in prison in Brazil

Cadernos de Saúde Pública ◽

10.1590/0102-311x00183616 ◽

2017 ◽

Vol 33 (11) ◽

Cited By ~ 4

Author(s):

Rosa Maria Soares Madeira Domingues ◽

Maria do Carmo Leal ◽

Ana Paula Esteves Pereira ◽

Barbara Ayres ◽

Alexandra Roma Sánchez ◽

...

Keyword(s):

Hiv Infection ◽

Pregnant Women ◽

Social Vulnerability ◽

Congenital Syphilis ◽

Incarcerated Women ◽

Mother To Child Transmission ◽

Child Transmission ◽

Syphilis Infection ◽

Free Women ◽

Mother To Child

Abstract: This study aimed to estimate the prevalence of syphilis and HIV infection during pregnancy, the mother to child transmission of syphilis and the incidence of congenital syphilis in incarcerated women in Brazil; to compare these rates to those observed in pregnant women outside of jail; and to verify the maternal factors associated with syphilis infection during pregnancy in free and incarcerated women. We used data from two nationwide studies conducted during the period 2011-2014. The Birth in Brazil study included 23,894 free women cared for in 266 hospitals. The Maternal and Infant Health in Prisons study included 495 incarcerated pregnant women or mothers living with their children, according to a census conducted in 33 female prisons. The same case definitions and data collection methods were used in both studies. The chi-square test was used to compare the characteristics of incarcerated and free women with a significance of 0.05. For incarcerated women, the estimated prevalence of syphilis during pregnancy was 8.7% (95%CI: 5.7-13.1) and for HIV infection 3.3% (95%CI: 1.7-6.6); the estimated mother to child transmission of syphilis was 66.7% (95%CI: 44.7-83.2) and the incidence of congenital syphilis was 58.1 per 1,000 living newborns (95%CI: 40.4-82.8). Incarcerated women had a greater prevalence of syphilis and HIV infection during pregnancy, lower quality of antenatal care and higher levels of social vulnerability. Syphilis infection showed to be an indicator of social vulnerability in free women, but not in incarcerated women. Health initiatives in prison are necessary to reduce healthcare inequalities and should include adequate antenatal and birth care.

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